1. September 25, 2013 MACDDS Meeting

2.  MSNT Background and History  MSNT as a pooled trust  Charitable Mission  Charitable Trust  MSNT as Trustee  Protecting Benefits  MSNT Services  Questions & Discussion

3.  Statute passed in 1989  Corporate status in 1990  First trust opened in 1991  Federal law exempting SNT as countable assets passed in 2003  Expanded service area in 2005 to surrounding states  Updated statutes in 2011  Relocated to independent offices in 2012  Surpassed 1000 trusts in 2013

4.  Created by Missouri Statute in 1989 as Missouri Family Trust, a public instrumentality of state government  Values-driven board appointed by Governor  Not for profit corporation with 501(c)3 status  Serves Missouri and surrounding states  Receives no state or federal appropriations

5.  MSNT qualifies as Pooled Trust  Special needs trusts must be established & administered by a non-profit organization  Trust agreements and distributions must conform to federal SSA requirements  Trusts for sole benefit of individual with a disability  State pay-back clause required  Federal allowance for pooled trust to retain all or part of the remaining amount at the death of the trust beneficiary

6. Exceptions for Counting Trust Resources for Persons with Disabilities  Federal Medicaid Regulations  Title 42 US Code Section 1396p(d)(4)(A)  Title 42 US Code Section 1396p(d)(4)(C)  State Eligibility Manual for PTD Medicaid  Link @ http://www.dss.mo.gov/fsd/iman/medasst/0805-015-10.htmlhttp://www.dss.mo.gov/fsd/iman/medasst/0805-015-10.html  SSI  Section 1917(d)(4)(A) of the Social Security Act  Section 1917(d)(4)(C) of the Social Security Act

7.  §402.199-402.208 RSMO establishes the Charitable Trust of the Missouri Family Trust  Governor-appointed and mission driven Board  Focus on service to PWD and their families  Affordable alternative to low to middle income families  MSNT has a statutory duty to protect public benefits for trust beneficiaries  Statute permits MSNT a 25% charitable retention at death of the life beneficiary  MSNT Board responsible for operational guidelines for the Charitable Trust

8.  Up to $1000 paid to vendor/provider directly  Only for goods and services prospectively based on estimate or treatment plan  Two categories  Urgent/dental  Twice a month  Staff review  General  Quarterly  Board review

9.  Disability determined by SSA verified by -  SSI for disability  SSDI  Income eligibility based on Federal Poverty Guidelines updated at the beginning of each fiscal year  Need demonstrated by treatment plan, estimated cost and application  US citizen and Missouri resident  No CT grant award in previous 12 months

10.  Completed & signed application form  Proof of disability  Proof of income  Estimate/treatment plan *MSNT will only consider complete applications!

11.  Grant award covers full cost of applicant need(s)  Matching funds from applicant or others  Provider offers discounted service  Grant would be cost effective in reducing future needs  High-value outcomes  One-time expenses, not ongoing commitments  Supplements but does not supplant Medicaid or Medicare coverage

12.  Applicant is in jail/prison  Application is incomplete or unsigned  Applicant or any member of the household has been disqualified from receipt of federal benefits due to a finding of fraud or failure to report to public benefit authorities  Request to reimburse another party for requested goods/services  Experimental or cosmetic  Applicant benefits have been reduced or suspended due to overpayment  Applicant fails or refuses to provide information about household  Applicant has history of felony convictions  Request is for vehicle, rent, utilities, groceries, cell phone  Covered by Medicaid/Medicare or other insurance

13.  Requested items are disposable and will need to be re-supplied continually for lifetime  Vehicle repair, parts, fuel or mileage, even for medical care  Item is available through accessible public venues such as books, equipment loan programs  More readily available through other charitable entities and not disability- related such as clothing or shoes  Applicant has failed to properly care for and protect similar assets or resources demonstrated by repeated or willful loss/destruction of personal property

14.  Approved by the Board each fiscal year  Total distributions = 50% of the charitable remainder +100% dividends and public contributions  For FY 14, $137,859 available for distributions

15.  Flexible program  Greater emphasis on quality of life and independence  Partnership potential

16.  Supplement to waiver budgets for ISL for appliances or adaptive equipment  Tuition and costs with programs like Warrensburg campus  Conferences for parents and PWD related to self determination and advocacy  Wonderland and other recreational or therapeutic camps  Ramps, lifts and other adaptive equipment to assist with community living as alternative to institutions  Communication and assistive devices not covered by Medicaid or waiver

17.  Donations are welcome!  Special Needs Trust administration supports Charitable Trust  MSNT is an affordable SNT option for 1 st and 3 rd party trusts  Referrals are welcome  Donor can increase remainder to CT or name other charitable purposes as remainder beneficiaries  Contact MSNT for to arrange for presentations and exhibit opportunities

18.  Currently administers over 1000 active accounts, mostly in Missouri with trust account assets exceeding $30 million  Contracts with a banking partner for account custodial services and investment management  In FY 13, the average size at opening was $25,500  Steady growth in number of accounts and total trust assets over the last decade

19.  MSNT has more than 20 years of experience  Provide consultation on use of trust funds  Staff and board knowledgeable about SSI, Medicaid and services to PWD  Minimizes co-trustee burden  Low minimum deposit & minimum account balance  Process distributions daily  Upon request, submits trust info to SSA/FSD  Reasonable administrative fees  MSNT offers investment choices for managing individual accounts

20.  Three vacancies  Governor appointed  Welcome you to identify interested parties  Quarterly meetings

21. Midwest Special Needs Trust PO Box 7629 Columbia, MO 65205 Phone: 573-256-5055 Toll free:1 877-239-8055 Fax: 1 573-303-5866 Email: mftbt@midwestspecialneedstrust.org Web: www.midwestspecialneedstrust.org

22.  Grant applications  First and Third party Trust Packets  MSNT Brochures Set up a special needs trust for Mary